NAFLD is associated with less severe liver fibrosis in chronic hepatitis B: a multi-center, retrospective study

Abstract Background and objective: Chronic hepatitis B (CHB) is vulnerable to more severe liver diseases, and is often accompanied by non-alcoholic fatty liver disease (NAFLD). NAFLD shares risk factors with liver fibrosis and cirrhosis in CHB, but the influence of NAFLD on progression is controversial. This retrospective study evaluated the prevalence of NAFLD in patients with CHB and investigated associations between NAFLD and liver fibrosis in these patients, in a large multi-center liver biopsy cohort. Methods: The cases of 1496 treatment-naïve patients with CHB who underwent liver biopsy were analyzed. Propensity score matching (PSM) was performed to adjust the confounders between patients with and without NAFLD. Results: NAFLD was diagnosed via liver biopsy in 290 (19.4%) patients. Compared to the non-NAFLD group, patients with NAFLD showed lower rates of significant liver fibrosis, advanced liver fibrosis, and cirrhosis (P<0.001, =0.003, =0.013, respectively). After PSM adjusted for age, gender, hepatitis B surface antigen, and hepatitis B virus DNA, 273 patients remained in each group. Liver fibrosis remained significantly less severe in the NAFLD group, compared with the non-NAFLD. NAFLD was an independent negative factor of significant liver fibrosis or advanced liver fibrosis in patients with CHB. Conclusions: CHB is often concomitant with NAFLD. The presence of NAFLD in CHB is associated with less severe liver fibrosis.